Gen­er­alised anx­i­ety dis­or­der higher among work­ers dur­ing eco­nomic down­turn — Ex­pert

Dr Lawal Ke­hinde is a con­sul­tant child and ado­les­cent psy­chi­a­trist with the De­part­ment of Child and Ado­les­cent Psy­chi­a­try, Univer­sity Col­lege Hos­pi­tal, Ibadan. He talks about panic dis­or­der and its treat­ment in this in­ter­view with


hat is panic dis­or­der?


Ac­cord­ing to the Di­ag­nos­tic and Sta­tis­ti­cal

of Men­tal Disor­ders, Fifth Edi­tion, panic dis­or­der is a type of dis­or­der that is char­ac­terised by re­cur­rent un­ex­pected panic at­tacks. In ad­di­tion to ex­pe­ri­enc­ing a panic at­tack, at least one panic at­tack must be fol­lowed by one month or more of the per­son fear­ing that they will have more at­tacks. It is not un­com­mon for peo­ple to have a panic at­tack dur­ing sleep. A panic at­tack is usu­ally very brief, of­ten last­ing less than three to five min­utes. Panic dis­or­der is one of the anx­i­ety disor­ders.

There are re­gions of the brain that un­der­lie our emo­tions. Any dys­reg­u­la­tion in the func­tion­ing of those re­gions may pre­dis­pose an in­di­vid­ual to hav­ing a panic at­tack. Ad­di­tion­ally, some peo­ple are more sen­si­tive to the nat­u­ral or nor­mal bod­ily sen­sa­tion that you and I ex­pe­ri­ence. For in­stance, any­one could feel an itch but that feel­ing is more in­tense for some­one who is likely to suf­fer a panic at­tack than for the gen­eral pop­u­la­tion, such that the mere ex­pe­ri­ence of that itch makes them worry that some­thing bad is go­ing to hap­pen to them. how does it af­fect the in­di­vid­ual so­cially?

Panic dis­or­der can be very de­bil­i­tat­ing. It can con­tinue for months or years, de­pend­ing on how and when treat­ment is sought. If left un­treated, it may worsen to the point where one’s life is se­ri­ously af­fected by panic at­tacks and by at­tempts to avoid or con­ceal the con­di­tion. In fact, many peo­ple have had prob­lems with per­sonal re­la­tion­ships, ed­u­ca­tion and em­ploy­ment while strug­gling to cope with panic dis­or­der. Some peo­ple with panic dis­or­der may con­ceal their con­di­tion be­cause of the stigma of men­tal ill­ness. In some in­di­vid­u­als, symp­toms may oc­cur fre­quently for a pe­riod of months or years, and then many years may pass with lit­tle or no symp­toms. In some cases, the symp­toms per­sist at the same level in­def­i­nitely. are there known causes?

We know that panic dis­or­der is as­so­ci­ated with sev­eral con­di­tions. The first thing is that it is im­por­tant to rule out some med­i­cal con­di­tions be­cause some of the symp­toms could be symp­toms of un­der­lined med­i­cal con­di­tions. For in­stance, there is a con­di­tion called thy­ro­tox­i­co­sis, whereby the hor­mone that drives how fast our body me­tab­o­lisms work can be high. So, if some­body has thy­ro­tox­i­co­sis, the per­son will have in­creased heart rates and other symp­toms that could be mis­taken for a panic at­tack.

Gen­er­ally, it tends to run in the fam­ily, i.e. it has a ge­netic ba­sis. In some cases, it is also as­so­ci­ated with some psy­cho-ac­tive sub­stance use, like nico­tine, cig­a­rette and cannabis. It could also be as­so­ci­ated with in­tense psy­cho­log­i­cal dis­tress from any cause, in­clud­ing sex­ual abuse, dif­fi­culty at work or re­cur­rent in­ter­per­sonal dif­fi­cul­ties. Th­ese can be termed as risk fac­tors.

It is also as­so­ci­ated with cer­tain per­son­al­ity traits. Re­search has shown that there is some cor­re­la­tion be­tween chil­dren with more fear­ful, anx­ious, or ner­vous per­son­al­ity types and later de­vel­op­ment of panic dis­or­der. None­the­less, the cause of panic dis­or­der is un­known and many men­tal health pro­fes­sion­als agree that it is most likely caused by a com­plex com­bi­na­tion of en­vi­ron­men­tal, bi­o­log­i­cal and psy­cho­log­i­cal fac­tors. What are the ma­jor signs to look out for when a per­son has panic at­tack?

A panic at­tack is char­ac­terised by four or more of the fol­low­ing symp­toms: pal­pi­ta­tions, pound­ing heart or an ac­cel­er­ated heart rate, sweat­ing, trem­bling or shak­ing, chest pain or dis­com­fort, sen­sa­tion of short­ness of breath or smoth­er­ing, nau­sea or ab­dom­i­nal dis­tress. Others are feel­ing dizzy, un­steady, light­headed or faint; feel­ing of un­re­al­ity (de­re­al­i­sa­tion) or be­ing de­tached from one­self (de­per­son­al­i­sa­tion); in­tense fear of dy­ing, dumb­ness or tin­gling sen­sa­tions and a gen­eral feel­ing of ner­vous­ness.

The af­fected per­son may feel that they are los­ing con­trol. So, it is a very dis­turb­ing ex­pe­ri­ence. Mul­ti­ple panic at­tacks could re­sult in a panic dis­or­der. Some­times, be­cause of the na­ture or how se­vere it is, in­di­vid­u­als may dread the re­cur­rence of a panic at­tack. Imag­ine that you are out­door, shop­ping or at a busi­ness meet­ing and you sud­denly have a panic at­tack. You would feel ashamed that ev­ery­body is looking at you. So, the fear of hav­ing a panic at­tack could make peo­ple iso­late them­selves, feel de­pressed and (it may) even in­ter­fere with their daily ac­tiv­i­ties. Gen­er­ally, symp­toms may be ex­pected when panic at­tacks are pro­voked by ex­po­sure to cer­tain sit­u­a­tions. In other in­stances, panic at­tacks are un­ex­pected. there have been grow­ing con­cerns about im­mi­nent job losses in Nige­ria due to the poor state of the econ­omy. Can such con­cerns in­crease the risk of panic at­tacks among Nige­ri­ans?

The an­swer is yes. Any­thing that per­turbs the mind can be as­so­ci­ated with a panic dis­or­der. We don’t par­tic­u­larly know why it hap­pens. but if some­body is un­duly wor­ried about their means of liveli­hood, it could lead to panic at­tacks. On the so­cioe­co­nomic sit­u­a­tion in Nige­ria, it is not im­pos­si­ble that it could be con­nected to a panic at­tack be­cause hav­ing a job is one of the things that give one ful­fil­ment and the threat of los­ing that could be very dis­turb­ing. Gen­er­alised anx­i­ety dis­or­der higher among work­ers dur­ing eco­nomic down­turn. Is panic dis­or­der ge­netic?

The ev­i­dence for ge­net­ics in cau­sa­tion of panic dis­or­der is fur­ther strength­ened by stud­ies among twins that show a higher like­li­hood of the sec­ond twin hav­ing panic dis­or­der, if the first twin al­ready has it in monozy­gotic twins com­pared with dizy­gotic. Is panic dis­or­der com­mon in a cer­tain age group?

Not par­tic­u­larly, it can oc­cur at any age. but it typ­i­cally de­vel­ops be­tween the ages of 18 and 35. Women are gen­er­ally more af­fected than men. Why?

It could be that men and women so­cialise dif­fer­ently. Men are taught from a younger age not to be weak. but women are more ex­pres­sive with what they go through. Ad­di­tion­ally, hor­monal fac­tors may be in­volved. how can the con­di­tion be di­ag­nosed?

ba­si­cally, a per­son suf­fer­ing from a panic at­tack needs to see a psy­chi­a­trist and have a com­plete eval­u­a­tion. It is very im­por­tant that med­i­cal con­di­tions are ex­cluded be­cause some med­i­cal con­di­tions could mimic a panic at­tack. Hyper­ten­sion and car­dio­vas­cu­lar prob­lems could mimic a panic at­tack. how can panic dis­or­der be treated?

One of the main ways of treat­ing panic dis­or­der is to use med­i­ca­tion to con­trol the ag­i­ta­tion and in­tense fear and there is a spe­cific class of med­i­ca­tion that we use. On the long term, how­ever, it is very im­por­tant to com­bine med­i­ca­tions with a form of treat­ment called psy­chother­apy, usu­ally the type called cog­ni­tive be­havioural ther­apy.


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